Technologies to Support Melanoma & Skin Cancer Awareness

“I thought I could beat anything. Then my doctor said: ‘You have skin cancer’ Melanoma is not the most common of skin cancers, but it is the most dangerous if not found in the early stages.”

Jane Green, Author
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Skin cancer is one of the most common cancer types worldwide: one in five people in the U.S. is expected to receive a skin cancer diagnosis. Early detection and treatment are invaluable: almost all skin cancers (both melanoma and nonmelanoma) can be cured if found and treated early. The American Cancer Society reports that across all stages of melanoma, the average five-year survival rate in the U.S. is 92%. The estimated five-year survival rate for patients whose melanoma is detected early is 98%. Prevention and detection are the key. One of the impacts of the COVID-19 pandemic has been a decrease in the number of patients visiting dermatologists to check for suspicious moles or changes in their skin. One fact dermatologists pointed out in a recent survey was that about 21% of melanomas might have gone undetected in 2020.

The annual cost of treating skin cancers there is estimated at $8.1 billion: about $4.8 billion for non-melanoma skin cancers and $3.3 billion for melanoma, which is a huge number. Fortunately, digital technologies are on their way to help dermatologists diagnose and treat skin diseases better and more effectively. After reviewing the current research on the topic, here are the key technologies that will help support the practice of dermatology in the coming years.

Teledermatology – Smartphones coupled with super-fast internet connections make it easy to send pictures or footage anywhere, so telehealth solutions appeared naturally in dermatology. The options of teledermatology services, as well as self-care platforms, are soaring. Companies like FirstDerm, Direct Dermatology, iDoc24, and SkinVision all work based on the same principle: they promise patients the option to self-check their symptoms and connect to a dermatologist online for consultation within a very short time. Usually, people can load up their photos to a particular platform, and smart algorithms and/or dermatologists give advice based on them. COVID-19 has given rise to telemedicine practices across the entire healthcare industry, but dermatology has been one of the easiest to adapt to the digital age. As the Journal of the American Academy of Dermatology” puts it, COVID-19 has removed “many restrictions that have roadblocked telehealth adoption.” There has historically been an immense shortage of dermatologists in the U.S. A 2017 estimate found that there were only 3.4 dermatologists per 100,000 people nationwide, and the average wait time to see one of them is 32.3 days. Even with all the obvious checks in the “pro” column—affordability, convenience, and accessibility—teledermatology still isn’t perfect. So, it’s essential to understand what conditions are best treated with teledermatology and which require an in-person visit.

Primary Care Physician Office – The DermaSensor is a handheld objective skin cancer sensing device that utilizes both pulses and light and spectroscopy to non-invasively identify information about a skin lesion at the subcellular level. More specifically, this device uses Elastic Scattering Spectroscopy (ESS), which measures and records photon scattering patterns as they reflect off different cellular structures following the input of quick bursts of light. ESS technology has been validated in more than 30 clinical publications that have demonstrated this technique’s utility in analyzing the macroscopic structure of both cellular and subcellular particles. Since malignant lesions scatter light at different intensities, the DermaSensor algorithm, derived from thousands of spectral samples of pathologically verified lesions, will immediately categorize a skin lesion as “Higher Risk” or “Lower Risk.” The DermaSensor device is intended to be used by primary care physicians in annual patient visits to check for suspicious skin lesions or changes in the skin since the last visit. PCPs will be able to use DermaSensor™ as an adjunctive tool to assess skin lesions better and determine whether an additional evaluation is needed.

Image Credit:, Accessed 5/4/2022

High-resolution, whole-body imagingExplicitly designed for dermatology, the VECTRA WB360 whole-body 3D imaging system from Canfield Scientific captures the entire skin surface in macro quality resolution with a single capture. The fully integrated software allows clinicians to map and monitor pigmented lesions and distributed skin diseases. Other applications include documenting pigmented lesions, psoriasis, and vitiligo.

Image Credit: Canfield Scientific

Wearable sensors – The clip-on QSun can detect UV exposure using five LED displays to indicate UV index. Once you shake it, it’ll let you know your UV index. That’s your measurement of how powerful ultraviolet radiation beaming from the sun is. The iOS and Android-friendly wearable keeps track of how long you have been out in the sun before you start to burn. When your time is up, it’ll vibrate to let you know that you should get in the shade. The QSun’s AI considers skin type to help determine the time that should be spent out in the sun. The Shade disc-shaped device is packed with sensors that can measure UVA and UVB rays and are even sensitive enough to do that with indoor light. The iOS and Android compatible wearable uses a magnetic clasp to wear on pretty much any piece of clothing, and it’ll keep you protected for five days before you need to power it up. If you like your wearables invisible, LogicInk will keep you safe in the sun with its Logic UV temporary tattoo. You stick the tat to your skin and watch its two rings throughout the day. There’s no phone or smartwatch involved. Simply keep your eyes on the tattoos. The smaller inner ring tells you how harsh the sun is by changing from white to purple. The outer, larger ring will turn bright pink from purple when you’re getting close to burning your skin.

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The dermatology app environment – Over the past few years, developers have created smartphone apps that help users monitor moles and lesions for any signs of progression to skin cancer. Popular apps include the following:

  • UMSkinCheck – The University of Michigan launched a free app that guides users through a complete home skin check exam. This app also offers the opportunity to create a mole library. This will enable people to compare and track any skin changes over time.
  • MoleMapper – The Oregon Health & Science University developed this app. It allows users to take photos and gather measurements of any moles on their bodies. Similar to UMSkinCheck, the app will enable users to take regular pictures of their moles to facilitate change tracking over time.
  • Miiskin – This app also allows users to take pictures to track their moles over time. Users can also pay for a version that lets them track large areas of skin. This may help them identify new marks and moles they might not have seen.
  • MoleScope – This is a high-resolution camera compatible with many different smartphones. This camera uses high magnification and special lighting to take more detailed and better quality photos than other skin cancer apps. It also contains many features that other apps do, such as skin mapping, image management, and regular reminders.
  • SkinVision – This app helps users identify high-risk moles that require further testing. The app classes each photo as either high or low risk. SkinVision also provides advice on the next steps to take.
  • Cureskin – The artificial intelligence-based app was developed by two engineers previously working by Google, and it aims to compensate for the lack of dermatologists in India. It can diagnose six common skin conditions – pimples, acne, scars, dark spots, pigmentation, and dark circles. The user takes a photo, the algorithm analyses the skin issues, the app’s chatbot asks a few questions, and, depending on the inputs, the A.I. recommends an eight-week skincare regimen.
  • Dermatology A to Z – The American Academy of Dermatology developed the Dermatology A to Z, specifically designed to serve consumers looking for skin health information. The app gives users evidence-based, dermatologist-approved health information, insights on diseases affecting skin, hair, and nails, and the latest medical and cosmetic treatments. Utilizing the smartphone’s GPS tracking system, the app can show the UV Index in real-time to fight against the dangers of ultraviolet radiation and find the nearest dermatologist in the area.
  • Eczema Tracker – Through the app, users can check pollen, mold, temperature, and humidity levels for any location, track the flare-up of eczema and get valuable advice on how to control and manage the condition for all ages. Through constant monitoring, patients have the chance to follow what triggers their symptoms and whether their medication can alleviate them.
Image Credit: Eczema

But are these apps accurate? Although the developers of some of these apps claim that they identify problematic moles and lesions accurately, research has shown that this might not be the case. A 2019 article in Trusted Source in the BMJ found several downsides to the available skin cancer apps, including a lack of testing to verify their effectiveness, a shortage of expert input when developing the technology, and issues with the technology itself. More scientific research will help doctors more clearly determine the accuracy of these apps. There are, however, some significant benefits to the regular reminders and the ability to photographically track moles or skin changes. For example, many people do not regularly check their skin. It can also be challenging to remember what a mole looked like last month or six months ago. Apps can provide valuable information to support advice from a doctor.

Where we’re going – Using advanced technologies to reduce the number of skin cancer issues could be crucial in pushing back the disease. Perceived value, trustworthiness, privacy, design, and costs are important barriers and facilitators regarding the use of mobile health applications (mHealth apps) for skin cancer screening, according to study findings published in the British Journal of Dermatology.

Digital Health: What We Can Learn From Other Countries Experiences

“Twenty percent of Estonians will have used our DNA analysis service by the end of this year and know which diseases they are susceptible to and how they can take appropriate precautions.”

Kersti Kaljulaid, Former President, Estonia – Interview in Der Spiegel
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Last week I received a book recommendation based on my previous reading on my Kindle device. The title was: The Year in Tech 2022: The Insights You Need from Harvard Business Review. I immediately purchased and downloaded it. Chapter three caught my eye – Want to See the Future of Digital Health Tools? Look to Germany. The chapter summarizes an online HBR article published the previous year (more on Germany later). And it got me thinking about whether there might be additional lessons to be learned from other countries as well. So, I set off to do some research. It turns out we can learn a lot.

The lead quote for this post, from the former President of Estonia, was a real eye-opener for me from a country we rarely discuss. Imagine a country where citizens will have their genetic profiles integrated into the digital health system with individual risk scores and pharmacogenomic information. When they go to the doctor, they will get fully personalized, genetic risk-based diagnosis, medication, and preventive measures. Estonians are very comfortable using e-services and sharing their data when necessary. Citizens are brought up with the philosophy that they own their data. However, it’s both the public and private sector’s job to use this data in the best way possible—to run their shared services smoothly and improve life in Estonia. Some essential facts:

  • In Estonia, 95% of health data is digitized
  • 99% of prescriptions are Digital
  • 100% of billing is done electronically
  • 94% of citizens are covered by national healthcare

They started to build their digital health system 20 years ago, and within the next few years, the Baltic country will reap the benefits of a transparent, blockchain-based, digital health system hooked on genetic data. The first fully digitized republic certainly sets the direction for other countries to follow. How have they done it? During the last twenty years, project e-Estonia has wired up the entire Baltic nation. The specific services that the government is involved with, legislation, voting, education, justice, banking, taxes, policing, and, naturally, healthcare, have been digitally linked across one platform, X-Road. Citizens can vote through their laptops, sign contracts with their digital signature, or use their chip-IDs when surfing around in the business and land registry – knowing that their data is secured through the blockchain and open to everyone. By having 78.1 percent of public bureaucracy digitized, the country also saves around 2 percent of its gross domestic product. For a deeper dive into the Estonian digital health experience, check out this excellent post from Dr. Bertalan Mesko and his team at The Medical Futurist Institute.

Next, let’s look at Finland, which ranks among the three strongest health technology economies globally. For centuries Finland has been collecting data precisely. And they also have been working for a long time to have their health and social care data digitized and harmonized. Finland has the National Data Exchange Layer, the equivalent of the Estonian X-road (starting to see a pattern here?). The interesting thing about this is that data can be exchanged, even between these two countries. They also have Kanta/My Kanta for Health data. These services are widely used by patients, even though they are relatively new. The system grants access to all healthcare information that the public system has about the person enquiring. People can renew electronic prescriptions, view records related to their treatment, store their living wills and organ donation testament, and consent to or refuse the disclosure of their personal data.

How about Denmark. The world’s third happiest country has one of the most advanced digital health systems alongside an elaborate and concise national digital health strategy for the next four years. The document emphasizes the importance of the cooperation of every healthcare actor through the easiest and fastest way, technology, with a clear purpose: to build an integrated network focusing on patients and looking at the person as a whole, not just at the individual diagnosis. Information on causes of death has been collected since 1875, and cancer incidence has been registered for the whole country since 1943. The Danish National Patient Registry has been keeping records that date 30-40 years back, making it one of the oldest nationwide hospital registries globally.

Another area where Denmark invests heavily is genomics-powered precision medicine – and things are moving fast. The Danish parliament adopted the law to establish the National Genome Center in 2018, and they built up their dedicated supercomputing infrastructure in 2019, began large-scale whole-genome sequencing to build up their accompanying genome database in July of that year. They believe that within the next five years, they will at least do 60,000 whole-genome sequences – at a minimum. Once again, The Medical Futurist Institute gives us a deeper understanding of the situation in Denmark in this post.

The health system in Sweden is founded on the principles of equal access and regional autonomy. Sweden recently updated its national eHealth vision, which now states that, by 2020, all residents aged 16 or over should have access to all health-related information documented in county-funded health and dental care. Two things enable this; a national patient portal and a national health information exchange platform. Although the county councils are autonomous and can prioritize which eHealth services to focus on, the decision was made at a national level that patients should only have one way to reach healthcare. A national patient portal, ‘’, is available for anyone seeking healthcare or health-related information in Sweden.

Sweden has chosen to implement a national Health Information Exchange (HIE) platform to facilitate the communication between different health information systems and eHealth services. The national HIE platform enables a single point of connectivity for client applications, making all Swedish EHRs appear like a national, virtual EHR. And citizens are responding. Preliminary results of a national patient survey among PAEHR users in Sweden indicate that the overwhelming majority of patients who have accessed the PAEHR are positive about it. Almost 90% of respondents completely agreed, and 8% partly agreed with the statement, “Having access to ‘Journalen’ is good for me.”

Now back to Germany – In late 2019, Germany’s parliament passed the Digital Health Care Act (Digitale-Versorgung-Gesetz, or DVG) — an ambitious law designed to catalyze the digital transformation of the German health care system, which has historically been a laggard in that area among peer countries. The timely introduction of the DVG means that Germany is poised to set an example for other countries in seeing what works (and what does not) in the adoption and diffusion of digital technologies for improving patient outcomes.

Perhaps the DVG’s most important provisions are its formalization of “prescribable applications” (Digitale Gesundheitsanwendungen, or DiGA), which include standard software, SaaS, and mobile as well as browser-based apps, and the creation of the Fast-Track Process, an accelerated regulatory path for companies to take their digital health applications to market. Following a streamlined review, an app can be added to a central registry of apps that can be prescribed by physicians and psychotherapists and will be reimbursed by all of Germany’s statutory health insurance providers, which cover 90% of the population of roughly 73 million individuals. The Fast-Track Process is run by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, or BfArM), which plays many of the same roles in Germany that the FDA does in the United States); BfArM also maintains the DiGA registry. The first five apps have already been added to the registry and offer support for patients to manage conditions including tinnitus, obesity, agoraphobia, osteoarthritis, and insomnia.

DVG promises to provide a standard care environment for manufacturers of new digital health tools to evaluate pricing strategies and understand how digital health applications fit into health care practice and patients’ everyday routines. The importance of such a major country mandating that all insurers have to pay for digital health apps is hard to overstate. With at least 50 apps currently already in the Fast-Track process and hundreds expected over the coming years from manufacturers worldwide, evaluation studies will create a wealth of data on how digital tools for remote patient care work in practice, which other payers and health systems can learn from. They will also be valuable in convincing health care providers — for whom evidence is of paramount importance — of the value of digital tools, both generally and in particular use cases.

Here’s a recently published update on the German DiGA journey with data through November, 2021.

So what can we learn from these examples? – There are several common elements to these national digital health programs that we could benefit from. But, and this is a crucial challenge, we would have to make major structural, payment, regulatory and legislative changes to how we currently operate. Here are my three major observations:

Interoperability is essential – Whether it’s X-Road in Estonia, My Kanta for Health in Finland, the National Patient Registry in Denmark, or in Sweden, the data is interoperable and accessible across all sites of care, and in some instances, across country borders. Contrast that with our experience. Ask the question: “What have the American people gotten for their $35 billion HITECH investment?” The answer is not much. Silos abound. Compiling a single, comprehensive patient record is impossible. We have no national patient identifier to prevent mixing patient records. Cybersecurity is dismal at best. All of this is in a country that spends more than 17% of GDP on health care and has an administrative overhead estimated to be over 8%.

Image Credit: OECD, 2019

Patients own their health and genetic data – Most citizens in the countries discussed above are brought up with the idea that they own their data, can control who has access to it and for how long. In those countries that are doing genetic profiles of their citizens, the patient controls the information and its use – in some instances, using blockchain technology to maintain security and authorization of access. Here, the accepted norm is that your provider “owns” your data. And although you can request a copy of your patient records, you’ll likely be charged for the privilege and will either receive the information in paper form on a disk that is of little use. While patient data advocates like Dave deBronkart Jr, widely known as e-Patient Dave, a cancer patient, and blogger who, in 2009, became a noted activist for healthcare transformation through participatory medicine and personal health data rights, and others push for this, progress is slow.

“Owning a copy of your personal data does not change property law, medical record requirements, or hinder the advancement of science. But it does build health equity by giving everyone equal access to their lifetime medical data.”

Juhan Sonin, Annie Lakey Becker and Kim Nipp, Stat First Opinion, November 15, 2021

Data ownership gives each of us the keys to our health puzzle and insight into how our data is used outside medical appointments to further research, innovation, and better health care for all. It gives us the keys we need to care for ourselves and our loved ones, and to build health in our communities and our country at large. Data ownership unlocks the path to achieving our health and wellness potential.

Including an individual’s genetic information is critical to personalized care. – In addition to Estonia, the NHS in the UK, Iceland, and the UAE have plans to sequence the DNA of large segments of the population to make citizens’ lives better. Here in the U.S., Boston Children’s Hospital had a five-year program where parents of newborns had the option of having the child’s DNA sequenced to test whether that information helps guide the care of babies and monitor how pediatricians and parents react to knowing it. Phase 1 of that study wrapped up in 2019. These plans likely won’t be perfect at first. But other nations looking to implement their systems might build off those, and citizens will be the ones to benefit.

Digital health tools development is a complex, multifaceted, and highly dynamic environment. While significant implementation challenges remain, I’m confident that there is a better chance of preparing for whatever is coming next by demonstrating the best practices of how other governments, regulators, and developers tackle the challenges of today.

Some Straight Talk on Digital Therapeutics (DTx) in Health Care

“Digital therapeutics (DTx) deliver medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders.”

The Digital Therapeutics Alliance
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A novel trend coming out of the fast-growing mobile health market, digital therapeutics are software products used to treat medical conditions. These products are designed to enable patients to take greater control over their care, similar to consumer wellness apps but with one key difference: Digital therapeutics focus on delivering clinical outcomes.

Particularly important in the definition above is that digital therapeutics are evidence-based, clinically evaluated software. However, while digital therapeutics are software-based, they are subject to the same regulatory oversight that traditional medicines undergo. This ensures that the product is safe to use, effective as well as has a clinical impact. They can also be prescribed independently or in concert with other medications or treatments to optimize patient outcomes.

First, some basic information on digital therapeutics – DTx products represent a new category of evidenced-based therapeutic technologies that support clinicians in delivering high-quality patient care. They address a range of disease states and provide a wide variety of software-based interventions. As defined by The Digital Therapeutics Alliance, DTx products are used independently or in concert with other medical therapies to:

  • Directly impact disease state measures and clinical outcomes
  • Expand access to safe, confidential, and effective medical treatments
  • Provide therapies for previously un- or undertreated conditions
  • Extend clinicians’ ability to care for patients
  • Maximize patient engagement
  • Close gaps in care
  • Lower overall healthcare costs

Digital therapeutics are not at a conceptual stage but are well within the production and delivery stages. DTx targeting chronic medical and mental conditions have been developed over the past 15 to 20 years. The Digital Therapeutics Alliance even has a product library of DTx. This list can be essential as it helps differentiate DTx that physicians can prescribe from unregulated apps that overpopulate online app stores. The organization says that all products claiming to be digital therapeutic must adhere to these foundational principles:

Image Credit: The Digital Therapeutics Alliance

Where are we today? – Extracting some examples from the product library referenced above gives us a sense of some diseases that can benefit from digital therapeutics.

One such product is Insula, a prescription-only software that assists type 2 diabetics in managing their condition. It recommends patients’ personalized insulin doses as well as acts as a coach in managing their diabetes. A randomized trial conducted in France showed that a precursor to the software helped improve glucose control compared with standard care.

Another example is Kaiku Health. The app supports cancer patients by allowing them to report potential symptoms that they might encounter; subsequently, it shares self-care instructions with them. Through Kaiku Health, patients can also message their care team. Studies have shown that such forms of digital monitoring lead to good patient adherence and satisfaction, as well as save time by reducing in-person visits or even phone consultations.

What are some of the challenges in implementing digital therapeutics?Reimbursement and oversight are two significant areas of concern in health care systems, yet the regulatory landscape surrounding DTx is still in flux. The first question that must be answered is who is responsible for regulating DTx. The second is the relation of DTx to machine learning and whether changes in software or updated machine learning algorithms would require reapproval or new approvals. The Total Product Lifecycle approach currently under consideration by the FDA could address some of these concerns.

System-level challenges of DTx also include cybersecurity. DTx interfaces with, and is reliant on, multiple nonmedical entities, including internet, phone, and cloud storage service providers. There are no global answers to these issues, but patients and clinicians alike will be reluctant to transmit sensitive health data over unsecured channels. Moreover, reimbursement for DTx is moving slowly. Some private insurers pay for DTx as prescribed, but nationwide reimbursement codes remain uncommon.

A yet unexplored problem is adherence to DTx use once prescribed; as large-scale implementation becomes a reality, this issue will need to be appropriately addressed. “App burnout,” a phenomenon referring to the short-term use of apps, may be relevant to DTx as the prescribed length of time (i.e., weeks, months, years) increases.

My take on the future of digital therapeutics – Digital therapeutics are not just a fad. They have the potential to address unmet patient needs that traditional treatments and therapies have been unable to meet. The ability of companies that leverage digital therapeutics to address these gaps, in combination with the much faster product development timelines, could give them a significant advantage over traditional life sciences companies.

“Digital therapeutics are poised to shift medicine’s emphasis from physically dosed treatment regimens to end-to-end disease management based on behavioral change.”

The Digital Therapeutics Alliance

The potential of digital therapeutics has players across multiple industries weighing their options. Technology giants are interested in developing and acquiring digital therapeutics to enter and change the health care landscape. Payers are exploring whether digital therapeutics can deliver better quality of life and outcomes while maintaining or reducing the overall cost of care in specific disease areas while independently analyzing how patient data, which could be collected through such products, can be leveraged to inform coverage. Start-ups are coming up with innovative digital therapeutic ideas to attract investors.

Thus far, the main DTx developments have been delivering already proven treatments via electronic/software means. However, the future of DTx will likely include higher-order constructs and products that address comorbid disorders.

Leveraging DTx to improve mental and physical health is likely to be the biggest, paradigm-shifting change that medicine has known since the invention of antibiotics. However, how to apply these tools remains an area that needs operationalization. DTx is at the nexus of digital innovation and scalability/wide-scale use of digital interventions, with more investment and exciting developments on the horizon.

The Health Care Metaverse – The Hype Train Has Arrived

“Let’s face it: healthcare was late to computers (well, at least to PCs). It was late to the internet. It was late to mobile. It still doesn’t understand the importance of social media or gaming. It isn’t even thinking about the metaverse.”

Kim Bellard, Contributor, The Health Care Blog
Image Credit:

The concept of the Metaverse has been around for years — science fiction writer Neil Stephenson is believed to have first introduced it in his 1992 novel Snow Crash. And folks who have read the Ready Player One novels are intimately familiar with the metaverse concept in the author’s depiction of OASIS, a vast virtual world where most of humanity spends their days. And, of course there’s The Matrix (red pill or blue pill?). But for purposes of this post it’s important to provide some background on the topic.

What is the metaverse? – The metaverse is the next evolution of the internet, in which users are immersed and virtually present. The metaverse consists of several key features, including real-time persistency, economies, communities, digital avatars, and accessibility across multiple devices. Early versions of the metaverse exist today, offering investors a glimpse of its enormous potential. But a successful metaverse in the future is expected to feature a decentralized, open-architecture platform accessed by virtual reality headsets and powered by blockchain technology. The concept, if successful, is expected to yield trillions of dollars of opportunities for companies stemming from several areas, including Social Media, Video Games, E-commerce, and Blockchain. In the metaverse, digital platforms will contribute mainly to digital-world experiences. By jumping into an immersive experience using a virtual reality headset, one can work, play video games, buy digital items, socialize with friends, and consume media, all while present within the metaverse itself.

As already noted above, versions of the metaverse already exist. If you have children, they might already be using platforms that support the metaverse. For example, Epic Games’ Fortnite has hosted virtual concerts with Ariana Grande and Travis Scott, where users attended as their digital avatars to enjoy the shared experience with others. The success of these events has been staggering, drawing millions of fans that far outnumbered in-person shows.

Half of American children use Roblox. Two-thirds of its users are 16 and younger, and most of them were spending lots of time at home last year. It is now estimated to have 37 million unique daily users, spending some 30 billion hours on the site last year. It is available in 180 countries, in 11 languages.

“We see a future where tens of thousands of people can gather in a single instance to join a virtual business conference, attend a movie premier, or watch their favorite artists perform live. We are working to make this vision a reality, innovating towards new technologies such as spatial audio and high-fidelity avatars with lifelike facial expressions.”

David Baszucki, CEO and Co-Founder, Roblox

What’s it all about? – One word – money. The metaverse is still in its early days, but the infrastructure is being built piece by piece, and social attitudes are changing such that we may soon be ready to experience a new era of the internet. While it may take several years for fully formed, immersive metaverse experiences to become ubiquitous, earlier stage investment opportunities emerge across multiple areas, including Social Media, Video Games, E-commerce, and Blockchain. At the heart of the opportunity are the social media and video game companies leveraging their large user bases, creator platforms, experiences with live digital events, and cutting-edge hardware to build the foundations of the metaverse. Beyond that, influential e-commerce firms are likely to benefit from new sales channels and features. At the same time, blockchain companies are likely to be essential in providing the financial infrastructure underpinning the metaverse economy. While in the real world, each of these themes continues to disrupt and redefine the status quo, the metaverse presents billions of dollars of new opportunities for each of these areas.

Image Credit: CB Insights

What does the concept of the metaverse have to do with health care? – Buzzwords like “health care metaverse” rarely live up to the hype. For all the adoption of EHRs, they still are not living up to the promise of better care and shared data. For all the trumpeted gains of telehealth during the pandemic, they’re already starting to dissipate. For all the investment in digital health, there’s no real evidence that it saves money or improves health. Healthcare usually takes new technologies and kludges them into submission.

“We overestimate the impact of technology in the short-term and underestimate the effect in the long run.”

Roy Amara, Stanford computer scientist, c1960

What we’ve experienced in the pandemic is an unprecedented acceleration and adoption of emerging technologies and a greater understanding of the vulnerabilities we have in managing global population health, as well as the opportunities offered by deploying innovative solutions powered by these emerging technologies. We’ve also seen the benefits of the digitization, decentralization, and democratization of health care in near real-time. Whether we continue to build on this progress or return to our “safe” pre-pandemic care routines is an open question. If you believe in the latter, you can stop reading now because creating a health care metaverse will rely on those technologies and lessons learned.

My take – We can already hear the drumbeat of the hype train accelerating as other industries promote the potential financial profits that the metaverse will bring. “Metaverse” is all the rage today, referenced by the leaders of Facebook, Microsoft, and Apple, but also by many other inhabitors of virtual worlds and augmented reality. The land of imaginary 3D spaces has grown at breakneck speed, and that was before the self-imposed isolation of a worldwide pandemic.

Not surprisingly, health entrepreneurs are all over the metaverse as well. Or at least they think they are. Many new ventures are led by current or former health executives, attracted by investor demand, selling marginal moves in telemedicine, robotics, behavioral health, consumer wearables, and the like. They see the health tech invasion of the metaverse as “a prescription for disruption” by a growing base of health technology investors armed with funding from special-purpose acquisition companies (SPACs).

But, here’s the problem. There are multiple challenges to creating a metaverse. The challenges fall into several domains such a technical (interoperability, portability, stakeholder customization), human factors (skills, resistance, mistrust, cyberattacks), legislative and regulatory. (Let’s be clear, our track record in achieving just data interoperability has been a dismal failure.) So, don’t expect anything resembling a workable version of a health care metaverse any time soon. Experience with past industrial revolutions would indicate that the transition to a metaverse-powered ecosystem will happen gradually, with an initial phase of hybrid education, hybrid processes, and hybrid delivery of care.

Health care needs a platform where user-created content and tools, among other things, can be built upon. It requires a platform that engages users using the latest technologies. No doubt, in the future, there will be opportunities to create a workable health care metaverse. In this new digitized, virtualized, and hyperconnected health care environment, one can envision a new Meta Health Care Delivery System that would likely be a hybrid of existing and novel technologies. Virtual Reality, Augmented Reality, and Mixed Reality would be combined with IoT, DLT, 6G or even 10G networks, robotics, brain-computer interfaces, AI, cloud, edge, and quantum computing and be deeply embedded in healthcare prevention, diagnosis, and treatment.

Additionally, healthcare payments, healthcare insurance, healthcare data governance, healthcare privacy, and security will also have to be transformed and adapted to the demand of a Metaverse society. Futurists like Dr. Bertalan Mesko and his team at The Medical Futurist Institute are predicting new personalized healthcare digital identities, digital avatars, and digital smart cities that will be the hallmark of the Health Metaverse. But the company that creates this platform probably won’t come from within health care.

And who will use this platform in the future? Your kids and grandkids will be the likely users of the health care metaverse since they’re already digital “natives” and comfortable interacting in these immersive digital universes.

I don’t know what the health care metaverse looks like. I doubt that anyone does. Will it be utopian or dystopian? No one knows that either. But in previous posts, I’ve highlighted some of the technologies that will be used to build out the health care metaverse. Concepts like the “digital twin” could interact with your physician’s avatar for a virtual visit. Patient communities built around specific conditions like “Patients Like Me” could meet in the metaverse to share what works and doesn’t work for them in a more rich, immersive environment. And education will undergo a dramatic transformation when it can become highly immersive and customizable for each individual. Whether we can combine all of the technologies required to build the health care metaverse into a working system is unknown at this time (I’m skeptical). Overcoming the legal and regulatory hurdles will be a considerable effort (Big understatement). And then there’s reimbursement (highly unlikely).

For now, tune out the hype, watch the technology development in other business sectors, and talk with your kids about their experiences on the immersive internet. They’ll be the best leading indicator about whether the metaverse will work in health care.

My prediction for widespread adoption of the health care metaverse in the next five years:

Some Straight Talk on Digital Health Sensors in Health Care

“We’ve come to a point in time where you can take the rich functionality of microelectronics and put it in new forms, fits and functions.”

Gregory Raupp, Professor of chemical engineering and research director of the WearTech Applied Research Center
Image credit: The Medical Futurist Institute

Health monitoring devices are taking center stage as the most practical use case for consumer wearable technology. What started years ago as stand-alone home health monitoring devices like heart-rate monitors, pedometers, and glucose monitors morphed into wearable fitness trackers. Then came smartwatches, which quickly started cannibalizing health functions. Fast forward a few more years, and there are now full-fledged wearable dedicated intelligent health devices. And it’s almost sure the technology and use cases will expand further in the coming years. Here are some current projections on the wearables market:

  • 1.3 million lives saved by wearables by 2020 — Swiss firm Soreon Research
  • $200 billion saved — Estimated global health cost savings from wearable tech over the next 25 years — Deloitte
  • 50% reduction in hospital visits — Projected reduction in hospitalizations through use of home monitoring devices of chronic diseases — California Telehealth Resource Center
  • $56.8 billion market value market projection for wearable tech by 2025 — MarketsandMarkets

A few years ago, wearable tech was rarely seen outside a lab or a clinic, where doctors used the devices to gather critical patient data or help with recovery. Today, wearable technology can come as a watch, a ring, a pair of contact lenses: a patch, or even a tattoo. The most familiar wearable technology in healthcare by far, for now, are fitness sensors and smartwatches. Chronic diseases like Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Hypertension, Dementia, and various behavioral conditions mean that the relevance of wearable technology in healthcare is bound to grow.

Wearable technology is helping people stay healthy in many ways. One of its foremost uses is in the prevention, detection, and management of chronic diseases. Depending on the disease condition, wearable healthcare technology could be vital for prevention, treatment, or control. Some conditions currently benefiting from wearable technology are:

  • Diabetes – Diabetes is the seventh leading cause of death in the United States and accounts for over $327 billion in direct and indirect costs.
  • Hypertension – In the US, almost half of adults have the condition.
  • Psychological issues – Over 50 million Americans are living with psychiatric conditions. Wearable health technology can assist with screening, monitoring, and diagnosing psychiatric disorders.
  • Heart disease – Wearables can monitor for conditions like AFib and other heart rhythm issues.

What are the Benefits of Healthcare Wearables? – An exhaustive listing of the potential benefits of wearable technologies is beyond the scope of a blog post. (The image at the top of this post is an excellent listing of currently available wearable technologies compiled by Dr. Bertalan Mesko and his team at The Medical Futurist Institute.) But some of the benefits include:

  • Protect an aging population – Recent studies have focused on developing wearable devices and associated algorithms to collect and analyze gait (manner of walking) data for fall prevention.
  • Tracking fitness – Fitness trackers have evolved into a global staple for athletes, sportspeople, and anyone interested in getting and staying fit. The personalized data they collect help doctors monitor activity levels and provide customized care. The development of biosensors has accelerated the adoption of this technology by expanding the form factors that can incorporate the technology. Biosensors are now incorporated into wearable technology, such as shirts, eyewear, wristbands, rings, patches, and even tattoos.
  • Blood Pressure & ECG – Electrocardiogram (ECG/EKG) monitors are the latest addition to wearable vital sign monitoring technology devices. ECG monitoring help people monitor their heart health and can help people detect strokes before they occur. The FDA has cleared medical-grade sensors like the Kardia mobile for several heart conditions. They even have developed a six-lead ECG version that provides a more complete picture of a patient’s ECG than their single-lead version.
  • Women’s Health issues – Several wearables are designed to help you figure out when you ovulate and when your next period is likely. Monitoring menstrual cycles may also be helpful if you have certain health conditions. If, for example, you have menstrual migraine, they might help you make predictions about your attacks.
  • Sleep disorders – Wearable technologies like the Oura ring can track sleep and provide valuable feedback on various sleep disorders.
  • Brain trainingVersus brain training was designed by neuroscientists, and it helps increase impulse control, regulate your emotions, stay focused and sleep better.
Image Credit: Rock Health

What are the potential drawbacks associated with wearable technologies? – While wearable healthcare technology essentially is beneficial, there are some ethical concerns to be aware of. It is possible devices could be hacked. Rigorous encryption is vital to protect user data. Users need to make sure they understand who can access their data and for what purposes. There may be situations where having real-time feedback on one’s physical or mental state could be unhelpful. Some users might find having too much information on their state at a given instant could make it hard to change that state.

How is the digital health care sensor market currently segmented? – Today, the digital health care sensor market is generally segmented into three areas:

  • Wearables – These are those sensors that are worn on the body like fitness trackers, smartwatches, smart clothing, and even temporary tattoos. For example, LifeSignals’ remote patient monitoring system consists of a single-use wearable biosensor that measures electrocardiography, heart rate, respiration rate, skin temperature and body posture data for up to five days. The biosensor wirelessly transmits the encrypted data to a secure cloud-based server; the data can be viewed on the accompanying app or on the remote monitoring dashboard.
  • Injestibles – These are sensors that can be swallowed and transmit data to a sensor worn outside the body like the pill sensors developed by the former company Proteus Digital Health or the PillCam. PillCam is a minimally invasive tool that allows doctors a direct view of the inside of your colon. It takes two images per second, over eight hours, transmitting them to an external sensor that connects to a computer to relay the data.
  • Insideables – Insideables are technologies that are implanted within the human body. They can be both controversial and hugely beneficial. A recent example of this type of technology is a bioabsorbable, transient pacemaker developed by researchers at Northwestern and George Washington University Hospitals.
Image Credit: Medtronic, Inc.

How are organizations implementing the use of digital sensors? – I have long been an admirer of the work being done by the Ochsner Health System in digital health. One of their signature initiatives was developing their version of Apple’s Genius Bar, which they call “O-Bar.” First opened in 2015, each O Bar is staffed with a technology specialist who can answer questions and provide demonstrations. These “genius” bars are where all patients can find the right tool for them and get set up to use it. O Bars are stocked with the latest digital health devices, ranging from wireless blood pressure cuffs to activity trackers, and equipped with iPads loaded with over 100 health apps that can be browsed and demoed before downloading to a personal device. Featured apps address a wide range of topics, including nutrition, fitness, women’s health, diabetes, and smoking cessation.

Image Credit: Ochsner Health

CVS Health has created a service designed to help CVS Caremark pharmacy benefit management clients more quickly roll out and manage third-party health products. Since it’s no easy task for an organization to vet the growing number of digital health products and services streaming onto the market, the Point Solutions Management program looks to stem this burden for its PBM clients by acting as a gatekeeper and ensuring that the digital health vendors it does recommend generate measurable clinical and financial benefits. Express Scripts has developed a similar program initially focused on prevention and management tools for diabetes and cardiovascular, behavioral, and pulmonary conditions, with support for more chronic and complex conditions to come. Watch for a more comprehensive look at the development of “digital health formularies” in an upcoming post this week.

What is the future of wearable technology? – The future of wearable technology in healthcare is bright. Wearable technology is expected to reach more people and has more disease prevention, detection, remote patient monitoring, and treatment applications. The devices are expected to become smaller and more efficient and will cost less. Artificial Intelligence and machine learning algorithms will automate collecting, analyzing, and reporting real-time clinical data to the care team. Wearable sensors will undoubtedly save more costs and save more lives.

Some Straight Talk on Remote Patient Monitoring in Health Care

“Treating patients in their home allows physicians to treat the whole patient. We see their individual needs and can integrate critical information, such as diet, physical environments and social determinants of health, into their care plans.”

Stephen Parodi, MD, executive vice president of the Permanente Foundation
Image credit:

Technological innovation has steadily changed the face of modern medicine over the years. The exponential growth in the development of on-body and in-body sensors has created new opportunities for personalized care outside of traditional healthcare settings. One of the significant shifts is the rise of remote patient monitoring to improve health outcomes and increase access to medical care. From 2016 to 2019, the number of people using connected wearable devices across the world has more than doubled, going from 325 million to 722 million users over three years. By 2022, it’s projected that wearable use will reach over one billion consumers. Insider Intelligence estimates 30 million U.S. patients, or 11.2% of the population, will use RPM tools by 2024—marking 28.2% growth from 23.4 million patients in 2020. According to a May 2021 survey by MSI International of some 300 consumers, between 65% and 70% said they’d be willing to participate in an RPM program with their care providers to monitor blood pressure, heart rate, blood sugar, and blood oxygen levels.

Many Americans have relied on this technology on their smartphones, fitness trackers, or smartwatches to provide health data in their day-to-day lives. Using technology to collect and analyze diet, exercise, and basic vital signs have been a part of many people’s personal efforts to improve their health and wellness. Healthcare providers have also incorporated these technologies to provide better care based on a larger and more accurate portrait of a patient’s health.

The COVID-19 pandemic has further influenced healthcare providers’ use of remote patient monitoring. As traditional healthcare sites such as clinics and hospitals became potentially dangerous vectors of transmission, healthcare providers increasingly turned to remote patient monitoring to track patients and help identify those who required in-person care.

Researchers at the Mayo Clinic Cancer Center have demonstrated that COVID-19 patients who got care at home via remote patient monitoring were considerably less likely to require hospitalization for their illness than COVID-19 patients who did not engage in the program. In-home equipment was used to monitor oxygen levels, vital signs, and symptoms of COVID-19 infection, and patients were managed by a centralized virtual care team of nurses and physicians. By November 2020, the initiative had assisted over 8,000 patients in rural and urban settings in 41 states across the U.S.

While many healthcare providers are just now getting into the remote patient monitoring arena, Ochsner Health has scaled its platform to a national level, and is now monitoring more than 20,000 people in health plans across the country. Ochsner is now marketing its RPM services to health plans and businesses around the country, charging a per-month per-member subscription fee. Ochsner says they’ve proven that the platform offers a 3:1 return for diabetes management and a 4:1 return for hypertension management, and they’re working on algorithms that would clarify ROI for other conditions.

What is remote patient monitoring? – Remote patient monitoring systems employ various devices such as implantables, biosensors, blood pressure cuffs, glucometers, and pulse oximetry to gather patient data remotely. There are sensors attached to the patient’s body that gather real-time data and keep sending it to the remote repository. Patients can also measure and share essential health data using different medical devices. Regular health checkups are replaced with round-the-clock monitoring, and qualified healthcare professionals regularly analyze the data.

Who uses remote patient monitoring? – Many methods of remote patient monitoring are designed to address chronic conditions like diabetes, heart conditions, and patients dealing with dementia. In cardiology, patients who used RPM had a 50% lower risk of death from arrhythmias and congestive heart failure than those who had regular, in-person follow-up, according to certain studies. CloudCath, a medtech company based in San Francisco, has created a remote monitoring technology that provides clinicians with data on the spent dialysate fluid of at-home peritoneal dialysis patients. CloudCath is incorporated into the drain line of peritoneal dialysis systems and wirelessly transmits data to the cloud, with proprietary algorithms then highlighting issues, such as infection, to clinicians.

As reported in an article by Megan Hernbroth in Business Insider (subscription required), Swift Medical makes an app that is primarily designed for nurses or clinicians caring for patients with chronic wounds, such as those in diabetic patients. It uses 3D image modeling and artificial intelligence to remotely reconstruct the wound digitally for caregivers, including measurements like width and depth that are hard to standardize in traditional care practices.

Image credit: Swift Medical

But even beyond these chronic conditions, remote patient monitoring can be a godsend for those without easy access to transportation or who live in areas that are far away from a healthcare provider.

What are the potential benefits of remote patient monitoring? – Multiple studies have demonstrated clear benefits for both healthcare organizations and patients themselves. A compilation of those findings are listed below: For healthcare organizations

  • A reduction in hospitalizations and the associated costs involved. The University of Pittsburgh Medical Center, for example, reduced the risk of hospital readmissions by 76% — and held patient satisfaction scores over 90% — by equipping patients with tablets and RPM equipment. A KLAS Research report surveying 25 healthcare organizations found 38% of healthcare organizations running RPM programs focused on chronic care management reported reduced admissions, while 17% cited cost reductions.
  • RPM saves time and increases the overall capacity for healthcare facilities and physicians to treat more patients, especially in areas like the Emergency Department.
  • Healthcare providers have easy access to the patient’s data and can remotely adjust the treatment plan for patients based on individual needs.
  • RPM solutions facilitate preventive care using reminders for patients to walk, exercise, or take medications, which is better than reactionary care.

For patients and their families

  • Remote Patient Monitoring programs can reduce out-of-pocket costs associated with chronic illnesses.
  • Remote patient monitoring facilitates more rapid access to healthcare.
  • The medical devices can remotely monitor vital signs for patients after surgery. This helps them comply with the aftercare and achieve healthcare targets.
  • Improved medication compliance, patients wear a sensor that detects and records their medication intakes, and hospital care providers track adherence in real-time.
  • RPM ensures access to essential health services for patients in rural or underserved areas. A recent publication titled: “Remote Patient Monitoring in the Safety Net: What Payers and Providers Need to Know” was commissioned by the California Health Care Foundation (CHCF) to offer providers, payers, and policymakers basic information about RPM and its potential application in the safety net. The report is based on research conducted separately by Public Health Institute and AVIA. The research was done between November 2020 and February 2021.
  • Overall improved quality of care.
  • And many of these programs give patients peace of mind in knowing their health is being monitored every day, perhaps even in real-time, by their care providers.

What is the outlook for the adoption of remote patient monitoring? – According to Consumer Technology Association (CTA), nearly 88% of healthcare organizations are investing or considering investing in remote patient monitoring systems. Apart from this, the research also showed that nearly 52% of consumers mentioned they would successfully use RPM solutions as part of their medical treatment if a physician made the recommendation.

What are some guidelines for developing and deploying a successful remote patient monitoring program? – In an excellent HBR article published in July 2020, authors Samantha F. Sanders, Ariel D. Stern, and William J. Gordon outline these guidelines drawn from their own experience managing remote-patient-monitoring programs, including one created specifically to care for Covid-19 patients, and research on the drivers of clinical success of established programs.

  • The technology must be accessible for both patients and clinicians to adopt and continue using.
  • The tools should be incorporated into clinician workflows.
  • Sources of sustainable funding must be identified and tapped.
  • Dedicate sufficient non-physician staff to operate the program.
  • Focus on digital health equity.
  • Start with an initial pilot and expand after demonstrated successes.

What is the future of remote patient monitoring? – Continued technological innovation and increased access to technology indicate a bright future of remote patient monitoring. The next trend in RPM technology is miniaturization. Device makers are making their solutions smaller and less invasive while partnering with new players to expand their market share.

Another trend is the development of in-body sensors that are bioabsorbable. For example, researchers at Northwestern and George Washington universities (GW) have developed the first-ever transient pacemaker — a wireless, battery-free, fully implantable pacing device that disappears after it’s no longer needed. The thin, flexible, lightweight device could be used in patients who require temporary pacing after cardiac surgery or while waiting for a permanent pacemaker. All components of the pacemaker are biocompatible and naturally absorb into the body’s biofluids over five to seven weeks without needing surgical extraction.

Such initiatives underline the fact that remote patient monitoring is ready to become a part of the mainstream healthcare industry and continue to grow even after the pandemic.

If you are interested in learning more about the underlying technologies that support remote patient monitoring, like 5G, RFID, Wifi, and Bluetooth, I highly recommend this online course from my friend and colleague Tom Giordano. His “Plain and Simple” series is excellent.

Image credit: Quovadis Learning Systems

Some Straight Talk on Voice-Enabled Technology in Health Care

“Voice recognition is the next killer app.”

Toby Cosgrove, M.D., former CEO, Cleveland Clinic
Image credit:

Voice technology has emerged as the next frontier for self-service in healthcare, promising a more “human” experience and enabling users to access information quickly without navigating a complicated interface. While the use cases are still developing, they promise myriad benefits to practitioners and patients alike – especially the elderly and disabled, those afflicted with chronic disease, or living in rural areas.

“Voice is the most obvious next step of user interface that is going to radically change the way we interact with technology.”

Dwight Raum, CTO of Johns Hopkins Medicine

In 2020, AI-powered chatbots and virtual assistants played a vital role in the fight against COVID-19. Chatbots helped screen and triage patients, and Apple’s Siri now walks users through CDC COVID-19 assessment questions and then recommends telehealth apps. Voice and conversational AI have made health services more accessible to everyone unable to leave their home during COVID-19 restrictions. Now that patients have a taste for what is possible with voice and healthcare, behaviors are not likely to go back to re-pandemic norms. Be prepared to see more investment in voice-tech integration in the healthcare industry in the years to come.

What are some potential use cases for voice-enabled technology in healthcare? – The most critical voice applications include disease management (system tracking, journaling, medication adherence), data collection, and cost reduction. In the future, the technology could evolve into a diagnostic tool using voice biomarkers like tone, inflection, breathing patterns, and more to detect abnormalities.

How do you justify the business case for voice-enabled technology? – Like any novel technology solution, voice must solve a business problem, such as engaging patients between doctor’s visits, improving access for patients in clinical trials, and removing friction in overall treatment.

“Think big from the outset and avoid framing a hyper-specific problem, otherwise you downplay the potential ROI and alienate stakeholders.”

Dan Solomon, professor of medicine at Harvard Medical School.

Are there practical examples of voice-enabled technology in use today? – As mentioned earlier, the COVID-19 pandemic accelerated the adoption of voice-enabled technologies like chatbots and virtual assistants. I like to segment the emerging use cases for voice-enabled technology into these categories:

Voice-enabled technologies for patient engagement – The most mission-critical use case for voice so far is symptom-tracking for patients with chronic illnesses. They may see their doctor episodically every two or three months, but in-between visits, voice assistants log and track their symptoms and adhere to medication by administering reminders or prompting the patient to schedule their next appointment.

Voice-enabled technologies for patient information services – These are platforms like Mayo Clinic’s First Aid skill on Alexa and WebMD’s symptom tracker. With voice assistants being essentially a “black box” lacking visual cues, they’re suitable for quick hits and guided interactions but not conveying lengthy or complicated information. Voice has also been shown to increase information retention when used to deliver medical advice versus reading a pamphlet.

Voice-enabled technologies for removing friction for healthcare providers – Health systems are using voice technology to administer assessment surveys on a daily or weekly basis to preemptively detect red flags and be up-to-date on the patient’s condition on their next visit.

Voice-enabled technologies in the examination room – Eric Schmidt from Google highlighted this use case in his keynote at the HIMSS 2018 conference. Whether it’s your Primary Care Physician, or a specialist practice, having a listening device in the room with your patient has a lot of potential for capturing clinical notes, identifying billing codes, or even providing clinical decision support during the encounter. It could also populate the physician’s visit notes into the EHR, potentially eliminating the burden of after-hours work.

Voice-enabled technologies in the operating room – There’s a lot to be said for interacting with devices in a sterile environment via voice. The most common concern is whether the surgical mask will muffle the sound too much, but so far this has not been an issue. If the environment is sufficient for you to hear and have a conversation with a human on the other side of the room, then speech recognition can be expected to work equally as well.

Voice-enabled technologies in the patient room or at home – Whether it’s staying in a hospital room or after discharging a patient to recover at home, voice interfaces represent a new opportunity to connect patients into their ecosystems, primarily when they have restricted mobility. Start with simple things like being able to dim lights, adjust the temperature of a room, control the audio levels. Voice can empower users to maintain control of their environment. Then, move to more integrated options, voice can also order food, request nursing assistance (and be able to articulate the reason for the aid so that nurses can prioritize appropriately), or find out more about their medical condition from trusted sources such as HealthWise and Health Navigator.

Voice-enabled technologies for Surveys, Feedback, and Clinical Trials – Surveys and clinical trials represent multiple opportunities to simplify user interaction and increase patient engagement. By providing a voice interface, we provide another touch point to gather information and allow users to do this while they’re completing other tasks.

Voice-enabled technologies for elder care – I participated in organizing and managing a trial use of Amazon Alexa devices in several assisted living facilities for tasks that ranged from reminders to home automation and personal or medical alert response systems. By the end of the trial, 100% of participants felt that Alexa overall made their life easier.

What are the challenges to the widespread adoption of voice-enabled technologies in health care? – Several obstacles remain for the widespread adoption of voice in a medical setting. They include:

  • HIPAA Compliance – While this limitation has slowed some organizations down, others are moving forward with the expectation that speech technologies will be compliant by the time their systems are complete.
  • Skills discovery – The Amazon Alexa marketplace has well-known challenges where the discoverability of new skills is problematic or unworkable.
  • Cumbersome Invocation Phrases – Having to say “Alexa, tell [My Skill] to do something,” or “Hey Siri” or “Hey Google” can be challenging to remember for skills you don’t use regularly, and more than a little repetitive when you’re using it often. Similarly, being able to interrupt a device once it’s started responding and chaining requests together so that we can ask for multiple things at once is critical – although we’re already beginning to see support for these functions.

It remains very early days for the use of voice assistants in healthcare. Consequently, provider organizations experimenting with the burgeoning technology do not have many hard results like return on investment to report. But these organizations are showing what the technology can do and have patients to back them up.

However, voice interaction is already becoming part of our everyday experience, and it’s natural that this will converge with our healthcare needs. There are currently pilot projects being tested today that utilize this technology in healthcare, many of which are still in a learning phase focused on establishing best practices for tomorrow’s medical devices. If you’re not using a voice interface already, start – it’s the best way to learn how they operate, and they’re not going away any time soon.

Health Tech News This Week – July 17, 2021

What happened in healthcare technology this week – and why it’s important.

Image Credit:

Amazon gets the green light from the FCC to use radar for monitoring sleep

As Mallory Hackett reported in Mobihealthnews, the retail giant filed for a waiver last month that would allow it to develop radar sensors that operate at higher power levels than currently allowed. In its request, Amazon described two possible use-cases for heightened radar capabilities, including touchless device control through basic gestures and movements and contactless sleep-tracking. The radar features would only be available in “non-mobile” devices when they’re connected to a power source, which could relate to reports that Amazon is quietly building sleep apnea-detecting technology in its Alexa devices.

“Granting the waiver will provide substantial public benefit by, among other things, permitting the deployment of applications that can provide assistance to persons with disabilities and improve personal health and wellness,”

FCC decision letter

Why it’s important – Amazon received its clearance based on a predicate device decision of Google’s Soli radar filing. In the case of Google’s second-generation Nest Hub, for example, a Soli radar sensor is used to track sleep patterns and things like people’s breathing rate in bed. Designed to be positioned on a nightstand, the intelligent display can monitor different sleep phases and then calculate an overall rating of how well the individual rested. The radar sensor can see movement at a granular level but no distinguishing features. That’s key if you want to encourage people to bring your device into their bedroom, where the idea of having an internet-connected camera switched on might be unpalatable.

Image credit: Google

The addition of Amazon adds to the list of companies providing touchless devices, including Google and Apple. Other digital health companies developing sleep-tracking technology include Itamar Medical, which recently acquired Spry Health to build out its wearable sleep apnea treatment, and Withings, which last year unveiled an under-the-mattress sleep tracking device.

Space-enabled drones deliver rapid coronavirus response

On July 13th in Tech Xplore online, The European Space Agency reported on a project with the NHS in Scotland using satellite-enabled drone technology to deliver medical supplies to remote areas during the pandemic. The project—which took place between June 2020 and May this year—was supported by ESA and the UK Space Agency as part of an initiative to accelerate the development of space-based solutions to COVID-19 and other pandemics.

Image credit: European Space Agency

The fleet took to the skies to ferry coronavirus tests and samples, medicines, and other much-needed equipment between medical practices in Argyll and Bute, a region of western Scotland that encompasses thousands of kilometers of coastline and several islands.

Drone delivery cut the average transport time in these sparsely populated remote communities from 21 hours using the existing road-based system to 60 minutes, enabling healthcare teams to provide COVID-19 diagnoses more speedily, which helped ease pressure on overstretched NHS services.

“Removing distance as a barrier to obtain faster results improved the quality and speed of service to patients, it also supported our doctors and nurses by providing faster results to aid and inform their decisions on care and treatment of their patients in our hospitals.”

Stephen Whiston, head of strategic planning, performance and technology at Argyll and Bute HSCP

Why it’s important – While there have been several projects looking at utilizing drone delivery in Singapore, Berlin, and India, this public/private partnership is an excellent example of how a clearly defined set of outcomes can expand the scope of activity in healthcare.

Researchers use machine learning to translate brain signals from a paralyzed patient into text

In a fascinating article in STAT, news intern Claudia López Lloreda reports on a study published Wednesday in the New England Journal of Medicine where researchers from the University of California, San Francisco, described an approach that combines a brain-computer interface and machine learning models that allowed them to generate text from the electrical brain activity of a patient paralyzed because of a stroke.

Assistive technologies such as handheld tablets and eye-tracking devices are increasingly helping give voice to individuals with paralysis and speech impediments who otherwise would not be able to communicate. Now, researchers are directly harnessing electrical brain activity to help these individuals. In a departure from previous work, the new study taps into the speech production areas of the brain to generate entire words and sentences that show up on a screen.


The researchers implanted an array of electrodes in the patient’s brain, in the area that controls the vocal tracts, known as the sensorimotor cortex. They measured the electrical activity in the patient’s brain while he was trying to say a word and used a machine-learning algorithm to then match brain signals with specific words. With this code, the scientists prompted the patient with sentences and asked him to read them as though he were trying to say them aloud. The algorithm interpreted what the patient was trying to communicate with 75% accuracy.

“The critical neural signals [for speech production] exist and that they can be leveraged for this application,”

Vikash Gilja, an associate professor at the University of California, San Diego

Why it’s important – Tapping brain signals to work around a disability is a hot field. In recent years, experiments with mind-controlled prosthetics have allowed paralyzed people to shake hands or take a drink using a robotic arm — they imagine moving, and those brain signals are relayed through a computer to the artificial limb. If the technology pans out, it eventually could help people with injuries, strokes, or illnesses like Lou Gehrig’s disease, whose “brains prepare messages for delivery, but those messages are trapped.”

Healing wounds and regrowing bones: Duke faculty develop futuristic biomaterial implants

An article in The Duke University Chronicle highlighted research into developing a metal, scaffold-shaped implant that could support the regrowth of a shattered bone. All that would be needed would be an initial CT scan, a virtual construction of the implant, and a metal printer to produce the final product.

Several Duke professors have made such futuristic biomaterial implants a reality, including Ken Gall, professor in the department of mechanical engineering and materials science; Shyni Varghese, professor of orthopedic surgery and Matthew Becker, Hugo L. Blomquist, distinguished professor of chemistry.

“It’s my hope that before I’m done with this … that one of the polymers developed in my lab actually makes it to a patient. And it looks like we’re getting close.”

Matthew Becker, Hugo L. Blomquist distinguished professor of chemistry

Gall’s research focuses on the use of 3D printed metals and polymers, including the metal as a mentioned earlier scaffold, using synthetic hydrogels for cartilage replacement and other related explorations. He also has initiated a new project investigating the types of structures that can be printed and is looking into utilizing machine learning or different algorithms to predict how these structures will behave.

Varghese’s research focused more specifically on utilizing the biomolecule adenosine. It proposed a biomaterial implant that can sequester this released adenosine during cell stress and ensure it stays in the body for a longer time to promote healing.

Why it’s important – The research reported here holds great promise in avoiding devastating outcomes like amputation or loss of the ability to walk. Implants that utilize adenosine can promote bone formation and prevent bone degeneration. Nanocarrier drug implants that can be administered orally can potentially treat bone loss caused by osteoporosis.

Swift Medical creates an AI powered app for the remote monitoring and management of wound care.

In an article published in Business Insider (subscription required), Megan Hernbroth reported on Swift Medical’s latest Series B funding round that raised $35 Million. The company makes an app primarily designed for nurses or clinicians caring for patients with chronic wounds, such as those in diabetic patients. It uses 3D image modeling and artificial intelligence to remotely reconstruct the wound digitally for caregivers, including measurements like width and depth that are hard to standardize in traditional care practices.

Image credit: Swift Medical

Chronic wounds are common in patients experiencing diabetes and other conditions. These patients are often in assisted-living facilities or home-bound, requiring extra care from nurses or other caregivers. Home-care nurses or nurses in skilled nursing facilities don’t always get the training they need to assess and treat chronic wounds properly.

Why it’s important – Because chronic-wound patients typically have repeat visits to emergency rooms, Swift contends that their app helps to reduce the costs associated with those visits by taking preliminary images in the home or facility the patient is already in.

Some Straight Talk on A.I. In Health Care

“Artificial Intelligence will help everyone become a better doctor in the future by eradicating waiting time, prioritizing emails, finding relevant information or making hard decisions rational.“

Bertalan Mesko, M.D. – Director, The Medical Futurist Institute
Image credit:

It’s important to separate the hype from the reality in our quest to incorporate A.I. into care delivery.

Image Credit: Sg2, Henry Soch Executive Summit presentation 2017

In a contributed article to Mobihealthnews on July 1st, Dr. Liz Kwo highlights her “Top 10 Use Cases for AI in Healthcare”. This comprehensive overview outlines the current major categories that health care providers are exploring to incorporate AI into the clinical care continuum. I applaud Dr. Kwo for synthesizing this information and share her enthusiasm for the potential of AI in supporting care teams in their daily work.

However, I do think it is important to balance the tremendous potential of the technology with the current reality. There’s an old saying that goes: “We overestimate the impact of technology in the short-term, and underestimate the impact in the long-term.” That certainly applies to AI in health care. The amount of “digital ink” devoted to the topic would fill several data warehouses.

CB Insights conducted a survey at the end of last year and asked which areas of healthcare would be impacted most by AI. The results are shown in the graphic below:

Image credit: CB Insights, 2020

Every year, Gartner publishes their “Hype Cycle” analyses across multiple industries. Their methodology helps us to separate the hype from reality when considering whether (and when) we decide to incorporate AI into clinical workflow. If you are not familiar with the Gartner Hype Cycle model, this is the best book that I’ve found on the subject: “Mastering the Hype Cycle: How to Choose the Right Innovation at the Right Time.”

Below is the Gartner Hype Cycle for Healthcare Providers 2020.

Image credit: Gartner, Inc.

We can see that, according to Gartner, AI is approaching the “Peak of Inflated Expectations”, and is not expected to reach “The Plateau of Productivity” for five to ten years. With that information as our baseline, let’s examine each of Dr. Kwo’s use cases and where we stand today.

1. AI supports medical imaging analysis – AI is used as a tool for case triage. It supports a clinician reviewing images and scans. This enables radiologists or cardiologists to identify essential insights for prioritizing critical cases, to avoid potential errors in reading electronic health records (EHRs), and to establish more precise diagnoses.

Where we are – The best assessment of where we stand in the implementation of AI in imaging can be found in an Aunt Minnie article by Michael Cannavo (akaPACSMAN) here. To quote him: “Unless you perform a large volume of studies that would benefit from the use of a CT algorithm stroke protocol, lung CT algorithm, or others, you may be hard-pressed to justify the purchase of AI software without obtaining additional revenue. There are significant advantages to using AI, but no clear path for how it will pay for itself in hard dollars.”

2. AI can decrease the cost to develop medicines – Supercomputers have been used to predict from databases of molecular structures which potential medicines would and would not be effective for various diseases. By using convolutional neural networks, a technology similar to the one that makes cars drive by themselves, AtomNet could predict the binding of small molecules to proteins by analyzing hints from millions of experimental measurements and thousands of protein structures.

Where we are – While many pharmaceutical companies and academic medical centers are exploring the use of supercomputers to help identify and develop new drug targets, the benefits are as of yet unproven. The introduction of “high throughput screening,” using robots to test millions of compounds rapidly, generated mountains of leads in the early 2000s but notably failed to solve inefficiencies in the research process. When it comes to AI, big pharma is treading cautiously. The technology has yet to demonstrate it can successfully bring a new molecule from computer screen to lab to clinic and finally to market.

3. AI analyzes unstructured data – In many cases, health data and medical records of patients are stored as complex unstructured data, which makes it challenging to interpret and access. AI can seek, collect, store and standardize medical data regardless of the format, assisting repetitive tasks and supporting clinicians with fast, accurate, tailored treatment plans and medicine for their patients instead of being buried under the weight of searching, identifying, collecting, and transcribing the solutions they need from piles of paper formatted EHRs.

Where we are – The author’s assertion that AI can collect, aggregate, and standardize all of this data regardless of the format is much easier said than done. The lack of data standards in healthcare continues to be the key stumbling block to an accurate, longitudinal patient record. And, collecting disparate data sets and placing that data in the proper context for review is a daunting challenge that has yet to be overcome.

4. AI builds complex and consolidated platforms for drug discovery – AI algorithms can identify new drug applications, tracing their toxic potential as well as their mechanisms of action.

Where we are – See the comments under point number two above.

5. AI can forecast kidney disease – In 2019, the Department of Veterans Affairs (VA) and DeepMind Health created a ML tool that can predict Acute Kidney Injury (AKI) up to 48 hours in advance. The AI tool was able to identify more than 90% of acute AKI cases 48 hours earlier than with traditional care methods.

Where we are – The partnership between VA and DeepMind Health continues. Its next target is to identify how this ML tool can be installed in medical units. A user-friendly platform is also targeted to support clinicians in their treatment decisions that would improve the quality of life for Veterans suffering from AKI.

6. AI provides valuable assistance to emergency medical staff – During a sudden heart attack, the time between the 911 call to the ambulance arrival is crucial for recovery. For an increased chance of survival, emergency dispatchers must recognize the symptoms of a cardiac arrest to take appropriate measures. AI can analyze both verbal and nonverbal clues to establish a diagnostic from a distance.

Where we are – Implementing these types of AI-assisted tools in the EMS is an expensive proposition. That, coupled with the fact that most EMS departments are run at the local town or city level, makes it difficult to achieve scale in deploying these tools. Also, one must consider the training requirements for proper implementation as well.

7. AI contributes to cancer research and treatment, especially in radiation therapy. In some cases, radiation therapy can lack a digital database to collect and organize EHRs, making the study and treatment difficult. To assist clinicians in making informed decisions regarding radiation therapy for cancer patients, a platform has been developed that collects the relevant medical data of patients, evaluates the quality of care provided, optimizes treatments, and offers specific oncology outcomes, data, and imaging.

Where we are – In a classic case of hype versus reality, consider IBM’s Watson and cancer care. Watson’s entry into cancer care and interpretation of cancer genomics was, just like its appearance on Jeopardy!, highly hyped, with overwhelmingly positive press coverage and little in the way of skeptical examination of what, exactly, Watson could potentially do and whether it could improve patient outcomes. An article in STAT looked at Watson for Oncology’s use, marketing, and actual performance in hospitals around the world, interviewing dozens of doctors, IBM executives, and artificial intelligence experts and concluded that IBM released a product without having fully assessed or understood the challenges in deploying it and without having published any papers demonstrating that the technology works as advertised, noting that, as a result, “its flaws are getting exposed on the front lines of care by doctors and researchers who say that the system while promising in some respects, remains undeveloped.” Quoting the STAT authors:

Perhaps the most stunning overreach is in the company’s claim that Watson for Oncology, through artificial intelligence, can sift through reams of data to generate new insights and identify, as an IBM sales rep put it, “even new approaches” to cancer care. STAT found that the system doesn’t create new knowledge and is artificially intelligent only in the most rudimentary sense of the term.

STAT – Casey Ross & Ike Swetlitz

8. AI uses data collected for predictive analytics – Turning EHRs into an AI-driven predictive tool allows clinicians to be more effective with their workflows, medical decisions, and treatment plan. NLP and ML can read the entire medical history of a patient in real-time, connect it with symptoms, chronic affections, or an illness that affects other family members. They can turn the result into a predictive analytics tool that can catch and treat a disease before it becomes life-threatening.

Where we are – The buzzword fever around predictive analytics will likely continue to rise and fall. Unfortunately, lacking the proper infrastructure, staffing, and resource to act when something is predicted with high certainty to happen, we fall short of the full potential of harnessing historical trends and patterns in patient data. In other words, without the willpower for clinical intervention, any predictor – no matter how good – is not fully utilized.

9. AI accelerates the discovery and development of genetic medicine – AI is also used to help rapidly discover and develop medicine with a high rate of success. Genetic diseases are favored by altered molecular phenotypes, such as protein binding. Predicting these alterations means predicting the likelihood of genetic diseases emerging. This is possible by collecting data on all identified compounds and on biomarkers relevant to specific clinical trials.

Where we are – If you live in the U. S. you’ve undoubtedly seen various cancer treatment centers talking about their personalized therapy plans, and especially how they’ll tailor things to your DNA sequence and so on. You would get the impression that we have an arsenal of specifically targeted cancer therapies, waiting for patients to get their tumors sequenced so they can be paired with the optimal treatment. That’s not true. I wish it were, but it just isn’t.

There are estimates that only about 15% of patients total are currently even eligible (under FDA guidelines) to have their tumors sequenced in the hope of matching with a targeted therapy. About one-third of those may actually benefit from the process in the end. This is not exactly what you’d expect if all you knew about this stuff was what you heard on TV. The thing is, that’s actually a significant advance because the number used to be zero in both categories. We really are making progress, and the people who can benefit really can benefit. It’s just that there aren’t nearly as many of them as we’d like, not yet.

10. AI supports health equity – Those responsible for applying AI in healthcare must ensure AI algorithms are not only accurate but objective and fair.

Where we are – Unfortunately, as has been demonstrated in many of the AI algorithms that exist today, we cannot assume that all relevant factors were applied in the training set of the AI algorithms. The medical datasets openly available for use by AI researchers are notoriously biased, especially in the US. It’s not a secret: Healthcare data is extremely male and extremely white, which has real-world impacts. (For a deeper discussion on this topic, check out Amber M. Hamilton’s article in Slate’s Future Tense Silicon Valley Pretends That Algorithmic Bias Is Accidental. It’s Not.) Questions that need to be addressed include: Is the selection of the training factors evidence-based? Are race, gender, and ethnicity data included in the training data set?

Adding a link here to an excellent, insightful blog post from John Halamka, M.D. titled “Learning from AI’s Failures. I love his concluding paragraph:

If we are to learn from AI’s failures, we need to evaluate its products and services more carefully and develop them within an interdisciplinary environment that respects all stakeholders.

John Halamka. M.D., President, Mayo Clinic Platform

AI holds great potential in improving care delivery by optimizing the use of scarce resources and eliminating repetitive and non-value-adding work for the care team. However, AI adoption in healthcare continues to have challenges, such as a lack of trust in the results delivered by an ML system and the need to meet specific requirements. It is essential to take a realistic approach when considering the implementation of AI in your organization. At this time, the best Return on Investment (RoI) case for AI involves operational use cases (e.g., bed management, staffing management, supply chain optimization, etc.) Certain clinical use cases like imaging, dermatology, and pathology can improve workflow and prioritize work lists for those disciplines.

I listed seven ways to prepare for incorporating AI in health care organizations during one of my presentations in 2017. I think they are still relevant today.

Image credit: Sg2, Henry Soch Executive Summit presentation 2017

If you are interested in digging a bit deeper into the topic of AI in health care, I highly recommend this online learning course from my friend and colleague Tom Giordano. His “Plain and Simple” series of courses are excellent.

Image credit: Quovadis Learning Systems